中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值与慢性肾脏病患者不良预后的相关性

Correlation of Neutrophils to Lymphocytes Ratio and Platelets to Lymphocytes Ratio with Poor Prognosis in Patients with Chronic Kidney Disease

目的探讨中性粒细胞与淋巴细胞比值(NLR)和血小板与淋巴细胞比值(PLR)与慢性肾脏病(CKD)患者不良预后的相关性。方法回顾性纳入2014年1—12月在安徽医科大学第二附属医院肾脏内科住院的CKD 3~5期非透析患者,采集基础数据及随访至2018年12月31日的终点事件(包括进入肾脏替代治疗或死亡)。根据NLR中位数分为高NLR组、低NLR组,根据PLR中位数分为高PLR组、低PLR组。比较各组间血红蛋白、白蛋白、血肌酐、尿酸、血糖、血脂、血钙、血磷、甲状旁腺激素等基础数据,各组发生终点事件的病例数,以及CKD患者肾脏预后的影响因素。结果中位随访期45.5个月(3~59个月),共有88例患者纳入研究。依据NLR中位数(2.495)分为高NLR组(NLR≥2.495)和低NLR组(NLR<2.495),各44例;依据PLR中位数(100.47)分为高PLR组(PLR≥100.47)和低PLR组(PLR<100.47),各44例。高NLR组舒张压高于低NLR组,血钙低于低NLR组(P<0.05);高PLR组男性患者比例、血钙水平低于低PLR组,血肌酐和全段甲状旁腺激素水平高于低PLR组(P<0.05或P<0.01)。Spearman相关分析提示,基线NLR与CKD分期呈正相关(r=0.273,P=0.010),基线PLR与CKD分期无相关性(r=0.170,P=0.114)。达到终点事件的患者46例(肾脏替代治疗43例,全因死亡3例),其中低NLR组17例,高NLR组29例;低PLR组15例,高PLR组31例;Kaplan-Meier分析结果显示,高NLR组累积生存率低于低NLR组(P<0.05),高PLR组累积生存率低于低PLR组(P<0.01)。单因素Cox回归分析结果显示,NLR、PLR是CKD患者预后不佳的危险因素(P<0.05)。多因素Cox回归分析,结果显示NLR、PLR预测CKD患者预后的作用降低,差异无统计学意义(P>0.05),高血压及血肌酐是CKD患者预后不佳的独立危险因素(P<0.05或P<0.01)。结论NLR和PLR升高与CKD患者不良预后有关,可作为预测CKD患者不良预后的标志物。

Objective To explore the correlation of neutrophils to lymphocytes ratio(NLR)and platelets to lymphocytes ratio(PLR)with the poor prognosis in patients with chronic kidney disease(CKD).Methods A retrospective analysis of CKD stage 3-5 non-dialysis patients admitted to the Department of Nephrology,the Second Hospital of Anhui Medical University from Jan.2014 to Dec.2014 was done,the basic data was collected and follow-up was done to the endpoint event on Dec.31st,2018.End-point events included renal replacement therapy or all-cause mortality.According to the median NLR,they were divided into a high NLR group and a low NLR group;according to the median PLR,they were divided into a high PLR group and a low PLR group.The differences of basic data such as hemoglobin,albumin,serum creatinine,uric acid,blood glucose,blood lipids,blood calcium and phosphorus,parathyroid hormone,and the number of cases with endpoint events between each group.The influence factors on prognosis of CKD patients were analyzed.Results The median follow-up period was 45.5 months(3-59 months).A total of 88 patients were included.According to the median NLR(2.495),they were divided into a high NLR group(NLR≥2.495)and a low NLR group(NLR<2.495),with 44 cases in each group.According to the median PLR(100.47),they were divided into a high PLR group(PLR≥100.47)and a low PLR group(PLR<100.47),44 cases in each group.The diastolic blood pressure of the high NLR group was higher than that of the low NLR group,and the blood calcium was lower than that of the low NLR group(P<0.05).The proportion of male patients and blood calcium level in the high PLR group were lower than those in the low PLR group,and serum creatinine and intact parathyroid hormone levels were higher than those in the low PLR group(P<0.05 or P<0.01).Spearman correlation analysis indicated that baseline NLR was positively correlated with CKD staging(r=0.273,P=0.010),while baseline PLR was not correlated with CKD staging(r=0.170,P=0.114).46 patients(43 cases on renal replacement therapy and 3 cases on all-cause death)achieved endpoint events,including 17 cases in the low NLR group and 29 cases in the high NLR group,15 cases in the low PLR group and 31 cases in the high PLR group.Kaplan-Meier analysis showed that the cumulative survival rate of the high NLR group was lower than that of the low NLR group(P<0.05),and the cumulative survival rate of the high PLR group was lower than that of the low PLR group(P<0.01).Univariate Cox regression analysis showed that NLR and PLR were risk factors for poor prognosis in CKD patients(P<0.05).Multivariate Cox regression analysis showed that the effect of NLR and PLR in predicting prognosis was decreased without statistical significance(P>0.05).Hypertension and serum creatinine were independent risk factors for poor prognosis of CKD patients(P<0.05 or P<0.01).Conclusion The increase of NLR and PLR is related to the poor prognosis of CKD patients and can be used as a marker to predict the poor prognosis of CKD patients.